Cross Point Community Church Babysitting Reimbursement Form

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Your Name
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Event NameWas this your small group? A church function?
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Babysitter Name 1Babysitter reimbursement is 10$ an hour/sitter for up to 2 hours.
First Name
Last Name
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Babysitter Name 2When groups of 6 or more deem the need for an extra sitter. (currently, we are only reimbursing 2 sitters/event)
First Name
Last Name
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Babysitter Name 3When you needed someone to fill in...if you used more than 4 or more sitters, please submit a separate form.
First Name
Last Name
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Phone Number
Area Code
Phone Number
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Address* This field is required.You will be paid via Bill Pay Check, mailed within 3 weeks of submission.
Zip Code
Address, City, and State
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E-mail
Your E-mail Address
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Monthly Ledger for Babysitter 1* This field is required.Please only submit one reimbursement request per month. You do not need to name the
Babysitting Date
First Name of Babysitter
Payment
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2
3
4
5
1
2
3
4
5
Babysitting Date
First Name of Babysitter
Payment
Babysitting Date
First Name of Babysitter
Payment
Babysitting Date
First Name of Babysitter
Payment
Babysitting Date
First Name of Babysitter
Payment
Babysitting Date
First Name of Babysitter
Payment
1 of 5
10
Total reimbursement for babysitter 1$
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Monthly Ledger for Babysitter 2Include any hours from Babysitter 3 here as well.
Babysitting Date
First Name of Babysitter
Payment Amount
1
2
3
4
5
1
2
3
4
5
Babysitting Date
First Name of Babysitter
Payment Amount
Babysitting Date
First Name of Babysitter
Payment Amount
Babysitting Date
First Name of Babysitter
Payment Amount
Babysitting Date
First Name of Babysitter
Payment Amount
Babysitting Date
First Name of Babysitter
Payment Amount
1 of 5
12
Total reimbursement for Babysitter 2$
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Total from Expense Babysitter 1 and 2$
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I certify* This field is required.
I certify that all information entered above is valid and true.
I have a previously documented communication (ie email/text) with an elder approving an application for reimbursement of babysitting services.
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Please verify that you are human* This field is required.
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Signature
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